Cervical and uterine diseases LAB 2009 Prof Dr Suzan Kato

acute cervicitis, the cervix is grossly red, edematous, with copious pus from the external os. Microscopically, an extensive infiltrate of polymorphonuclear leukocytes and stromal edema. Microscopically, an extensive infiltrate of polymorphonuclear leukocytes and stromal edema. chronic cervicitis, more common, the cervical mucosa is hyperemic, + erosions. Microscopically, the stroma is infiltrated by mononuclear cells, lymphocytes and plasma cells. Metaplastic squamous epithelium of the transformation zone may extend into endocervical glands Microscopically, the stroma is infiltrated by mononuclear cells, lymphocytes and plasma cells. Metaplastic squamous epithelium of the transformation zone may extend into endocervical glands Inflammations of the cervix morphology

Cervicitis

chronic cervicitis Small round dark lymphocytes are seen in the submucosa, and there is also hemorrhage.

Condyloma accuminatum GROSS GROSS papillary and elevated or flat. papillary and elevated or flat. singly OR multiple. singly OR multiple. range from a few mms to many cms in diameter range from a few mms to many cms in diameter red-pink to pink-brown red-pink to pink-brown

Condyloma Acuminatum MP:hallmarks of HPV infection. perinuclear cytoplasmic vacuolization perinuclear cytoplasmic vacuolization nuclear angular pleomorphism nuclear angular pleomorphism acanthosis acanthosis hyperkeratosis hyperkeratosis koilocytosis. koilocytosis.

Normal cx (left) turning into CIN (right) CIN

Gross Grossly invasive carcinomas takes one of the following forms: Grossly invasive carcinomas takes one of the following forms: fungating mass, ulcerative or infiltrative 8Prof DR Suzan Kato

Invasive Cervical carcinoma

Prof DR Suzan Kato10 Microscopically, there are three different types of invasive carcinoma: (1)large cell, nonkeratinizing squamous carcinoma—the most common type, with the best prognosis (2)keratinizing squamous carcinoma—next most common, with an intermediate prognosis; (3) small cell carcinoma—rare, with a poor prognosis. (4)Endocervical adenocarcinoma accounts for 10–15% of cervical cancers. It arises in the endocervical glands

Invasive Sq cc

Tuberculous endometritis

They vary in size from 0.5 to 3 cm and are covered by endometrial epithelium. Microscopically, composed of endometrial glands and a fibrovascular stroma. Clinically, endometrial polyps may be asymptomatic or may cause excessive uterine bleeding. Endometrial polyps

Uterine polyp A -single polyp extends into the endometrial cavity. The necrotic tip is responsible for clinical bleeding. B. On microscopic section, a polyp exhibits dilated endometrial glands embedded in a markedly fibrous stroma.

Endometrial Polyp:

Adenomyosis The uterus may be enlarged. The myometrium discloses small, soft, cysticareas Adenomyosis The uterus may be enlarged. The myometrium discloses small, soft, cystic areas

Adenomyosis endometrial glands and stroma in the myometrium.

End hyperplasia The endometrial cavity is opened to reveal lush fronds of hyperplastic endometrium. The endometrial cavity is opened to reveal lush fronds of hyperplastic endometrium.

Endometrial hyperplasia SimpleComplexAtypical A, Anovulatory or "disordered" endometrium with dilatation of glands. B, Complex hyperplasia displaying a nest of closely packed glands. C, Atypical endometrial hyperplasia with crowding of glands, unfolding of tall columnar cells, and some loss of polarity.

Leiomyoma Multiple leiomyomas of the uterus. Several large, almost pedunculated tumors protrude from the dome of the fundus. The lower uterine segment and cervix are below Multiple leiomyomas of the uterus. Several large, almost pedunculated tumors protrude from the dome of the fundus. The lower uterine segment and cervix are below

Leiomyoma: Microscopically leiomyomas exhibit interlacing fascicles of uniform spindle cells, in which nuclei are elongated and have blunt ends. The cytoplasm is abundant, eosinophilic, and fibrillar. leiomyomas are distinguished by their circumscription, nodularity, and denser cellularity

Leiomyosarcoma: bulky masses infiltrating the uterine wall, as polypoid lesions projecting into the uterine cavity, soft, hemorrhagic, and necrotic soft.has irregular borders due to invasion into neighboring myometrium

leiomyosarcoma Criteria of malignancy include necrosis, cytologic atypia, and mitotic activity. Criteria of malignancy include necrosis, cytologic atypia, and mitotic activity.

24Prof DR Suzan KatoCompare

LeiomyomaLeiomyosarcoma

Endometrial cancer grows in a diffuse or exophytic pattern involve multiple areas. Large tumors are usually hemorrhagic and necrotic

Endometrial Carcinoma 27Prof DR Suzan Kato

ENDOMETRIOID ADENOCARCINOMA is the most common histologic variant (60%). The FIGO system divides this tumor into three grades. Grade 1: Well differentiated; composed almost exclusively of neoplastic glands, with only minimal (<5%) solid areas. Grade 2: Moderately differentiated; formed partly of glandular elements and partly (<50%) of solid tumor. Grade 3: Poorly differentiated; shows large (>50%) areas of solid tumor

Endometrial carcinoma: A, Endometrioid type, infiltrating myometrium and displaying cribriform architecture. B, Higher magnification reveals loss of polarity and nuclear atypia. 29Prof DR Suzan Kato

Complete mole The uterus is usually enlarged. The uterus is usually enlarged. The uterine cavity is filled with a mass of grape-like structures—thin-walled, translucent, cystic, and grayish-white. The uterine cavity is filled with a mass of grape-like structures—thin-walled, translucent, cystic, and grayish-white. No fetal parts are identified. No fetal parts are identified.

Hydatidiform Mole: 31Prof DR Suzan Kato

Complete hydatidiform mole suspended in saline showing numerous swollen (hydropic) villi

Microscopically, the cysts are composed of dilated chorionic villi, the interior being filled with an avascular, loose myxoid stroma. the cysts are composed of dilated chorionic villi, the interior being filled with an avascular, loose myxoid stroma. Trophoblastic proliferation produces sheets of cytotrophoblastic and syncytiotrophoblastic cells Trophoblastic proliferation produces sheets of cytotrophoblastic and syncytiotrophoblastic cells Cytologic atypia may be present. Cytologic atypia may be present.

complete mole showing distended hydropic villi and proliferation of the chorionic epithelium

Partial Mole The uterus may not be enlarged. The uterus may not be enlarged. The enlargement and edema involves only a proportion of villi, and many normal villi coexist. The enlargement and edema involves only a proportion of villi, and many normal villi coexist. Fetal parts may be present. Fetal parts may be present. The degree of trophoblastic proliferation is mild The degree of trophoblastic proliferation is mild level of chorionic gonadotropin is slightly elevated. level of chorionic gonadotropin is slightly elevated.

Morphology of Choriocarcinomas Grossly the tumor usually appears as very hemorrhagic, necrotic friable mass within the uterus. Sometimes the necrosis is so complete that anatomic diagnosis is difficult. Grossly the tumor usually appears as very hemorrhagic, necrotic friable mass within the uterus. Sometimes the necrosis is so complete that anatomic diagnosis is difficult.

MP the tumor is purely epithelial, composed of anaplastic cuboidal cytotrophoblast and syncytiotrophoblast associated with necrosis and hemorrhage. the tumor is purely epithelial, composed of anaplastic cuboidal cytotrophoblast and syncytiotrophoblast associated with necrosis and hemorrhage. In contrast to the case with hydatidiform moles and invasive moles, chorionic villi are not formed In contrast to the case with hydatidiform moles and invasive moles, chorionic villi are not formed

choriocarcinoma illustrating both neoplastic cytotrophoblast and syncytiotrophoblast with no villi.